Provider Demographics
NPI:1952329385
Name:JONES, MITCHELL TAYLOR (MD)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:TAYLOR
Last Name:JONES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2500 STARLING ST
Mailing Address - Street 2:SUITE #404
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4219
Mailing Address - Country:US
Mailing Address - Phone:912-264-1520
Mailing Address - Fax:912-264-1526
Practice Address - Street 1:2500 STARLING ST
Practice Address - Street 2:SUITE #404
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4219
Practice Address - Country:US
Practice Address - Phone:912-264-1520
Practice Address - Fax:912-264-1526
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA035448207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000743212BMedicaid
GAG46629Medicare UPIN